Effects of an In-home Multicomponent Exergame Training on Physical Functions, Cognition, and Brain Volume of Older Adults: A Randomized Controlled Trial

Abstract

Aging is associated with a decline in physical functions, cognition and brain structure. Considering that human life is based on an inseparable physical-cognitive interplay, combined physical-cognitive training through exergames is a promising approach to counteract age-related impairments. The aim of this study was to assess the effects of an in-home multicomponent exergame training on [i] physical and cognitive functions and [ii] brain volume of older adults compared to a usual care control group. Thirty-seven healthy and independently living older adults aged 65 years and older were randomly assigned to an intervention (exergame training) or a control (usual care) group. Over 16 weeks, the participants of the intervention group absolved three home-based exergame sessions per week (à 30-40 min) including Tai Chi-inspired exercises, dancing and step-based cognitive games. The control participants continued with their normal daily living. Pre- and post-measurements included assessments of physical (gait parameters, functional muscle strength, balance, aerobic endurance) and cognitive (processing speed, short-term attention span, working memory, inhibition, mental flexibility) functions. T1-weighted magnetic resonance imaging was conducted to assess brain volume. Thirty-one participants (mean age = 73.9 ± 6.4 years, range = 65-90 years, 16 female) completed the study. Inhibition and working memory significantly improved post-intervention in favor of the intervention group [inhibition: F ₍₁₎ = 2.537, p = 0.046, ${\text{n}}_{\text{p}}^2$ = 0.11, working memory: F ₍₁₎ = 5.872, p = 0.015, ${\text{n}}_{\text{p}}^2$ = 0.02]. Two measures of short-term attentional span showed improvements after training in favor of the control group [F₍₁₎ = 4.309, p = 0.038, ${\text{n}}_{\text{p}}^2$ = 0.03, F ₍₁₎ = 8.504, p = 0.004, ${\text{n}}_{\text{p}}^2$ = 0.04]. No significant training effects were evident for physical functions or brain volume. Both groups exhibited a significant decrease in gray matter volume of frontal areas and the hippocampus over time. The findings indicate a positive influence of exergame training on executive functioning. No improvements in physical functions or brain volume were evident in this study. Better adapted individualized training challenge and a longer training period are suggested. Further studies are needed that assess training-related structural brain plasticity and its effect on performance, daily life functioning and healthy aging.

Keywords: brain volume; cognition; exergame; healthy aging; physical functions; physical-cognitive training.

Figure 1

Set up and navigation in the Active@Home exergame. The hardware of the Active@Home exergame consists of four inertial measurement units (IMUs). For movement evaluation, participants wore the sensors at wrists and ankles. Color and size of the bracelet helped to distinguish the position of each IMU. The IMUs were connected via Bluetooth to a HDMI dongle. This dongle was inserted into a television and provided the exergame software. The game interface was presented on the TV screen. By pointing the IMU on the right wrist horizontally to the TV screen, a “hand mouse” got activated for navigation through the game.

Figure 2

Study flow chart. Screening for eligibility included a health questionnaire and the Mini Mental Status Examination. Eligible participants were randomly assigned to either training or control group. The participants of the training group trained 3x/week à 30–40 min for 16 weeks while the participants of the control group continued with their normal daily living. Physical and cognitive functions as well as brain volume were assessed before and after the intervention period.